JC Meurice, I Marc and F Series
Unite de Recherche, Hopital Laval, Universite Laval, Quebec, Canada.

The auto-CPAP (Morphee Plus) is characterized by its ability to modify the positive-pressure level applied during the night for the presence or absence of sleep-induced respiratory disorders. The aim of the study was to compare the efficacy of this new mode of CPAP therapy with that of conventional constant-CPAP in the treatment of sleep apnea/hypopnea syndrome (SAHS). Sixteen patients with SAHS were randomly allocated to two groups that were paired for age, apnea/hypopnea index, and mean sleep latency. In the auto-CPAP group, the pressure level could change within fixed limits in both directions (+2 to -4 cm H2O) of the previously determined effective pressure level (Peff). In the constant- CPAP group, patients used the same apparatus (Morphee Plus) in a constant mode at Peff level. At the beginning of the study, the Peff level was determined during a polysomnographic recording. Day-time vigilance was measured subjectively by a standardized questionnaire and objectively by the maintenance of wakefulness test (MWT); Trailmaking tests (TMT) were used to evaluate cognitive functions. After 3 wk of home CPAP therapy, a control sleep study was done with the CPAP machine used in the protocol, and daytime vigilance and cognitive function tests were obtained. Baseline sleep and nocturnal breathing disorders characteristics did not differ between the two groups, and daytime vigilance and cognitive function abnormalities were similarily altered. In both groups, the apnea/hypopnea index was within normal range at the final CPAP sleep study. In the auto-CPAP group, 49.3 +/- 14.9% (mean +/- SD) of home treatment time was spent at a pressure < or = Peff. Home amount of use estimated by the number of sleeping hours with a positive pressure applied was 6.5 +/- 1.0 h in the auto-CPAP group and 5.1 +/- 1.1 h in the constant-CPAP group (p = 0.02). During the control CPAP sleep study, the positive pressure level was significantly lower during Stage III-IV than during the other sleep stages (p = 0.004). The improvement in the MWT and the TMT observed with CPAP therapy was identical in both groups. We conclude that (1) the amount of use during CPAP treatment is higher with auto-CPAP than with constant-CPAP, and (2) Morphee+auto-CPAP is an efficient as conventional CPAP in correcting nocturnal breathing disorders, daytime sleepiness, and cognitive impairment in SAHS.

This article has been cited by other articles:

				A. Ozsancak, C. D'Ambrosio, and N. S. Hill Nocturnal Noninvasive Ventilation Chest, May 1, 2008; 133(5): 1275 - 1286. [Abstract] [Full Text] [PDF]

				D. Rodenstein Determination of Therapeutic Continuous Positive Airway Pressure for Obstructive Sleep Apnea Using Automatic Titration: Promises Not Fulfilled Chest, March 1, 2008; 133(3): 595 - 597. [Full Text] [PDF]

				O. Marrone, A. Salvaggio, S. Romano, and G. Insalaco Automatic Titration and Calculation by Predictive Equations for the Determination of Therapeutic Continuous Positive Airway Pressure for Obstructive Sleep Apnea Chest, March 1, 2008; 133(3): 670 - 676. [Abstract] [Full Text] [PDF]

				D. Pevernagie, J. F. Masa, J. C. Meurice, R. Farre, O. Marrone, and D. Rodenstein Treatment of obstructive sleep-disordered breathing with positive airway pressure systems Eur. Respir. Rev., December 1, 2007; 16(106): 125 - 131. [Abstract] [Full Text] [PDF]

				Y. Nussbaumer, K. E. Bloch, T. Genser, and R. Thurnheer Equivalence of Autoadjusted and Constant Continuous Positive Airway Pressure in Home Treatment of Sleep Apnea Chest, March 1, 2006; 129(3): 638 - 643. [Abstract] [Full Text] [PDF]

				M. S. Aloia, M. Stanchina, J. T. Arnedt, A. Malhotra, and R. P. Millman Treatment Adherence and Outcomes in Flexible vs Standard Continuous Positive Airway Pressure Therapy Chest, June 1, 2005; 127(6): 2085 - 2093. [Abstract] [Full Text] [PDF]

				P Gordon and M H Sanders Sleep {middle dot} 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome Thorax, January 1, 2005; 60(1): 68 - 75. [Abstract] [Full Text] [PDF]

				J. F. Masa, A. Jimenez, J. Duran, F. Capote, C. Monasterio, M. Mayos, J. Teran, L. Hernandez, F. Barbe, A. Maimo, et al. Alternative Methods of Titrating Continuous Positive Airway Pressure: A Large Multicenter Study Am. J. Respir. Crit. Care Med., December 1, 2004; 170(11): 1218 - 1224. [Abstract] [Full Text] [PDF]

				F. Abdenbi, B. Chambille, and P. Escourrou Bench testing of auto-adjusting positive airway pressure devices Eur. Respir. J., October 1, 2004; 24(4): 649 - 658. [Abstract] [Full Text] [PDF]

				A. Bachour and P. Maasilta Mouth Breathing Compromises Adherence to Nasal Continuous Positive Airway Pressure Therapy Chest, October 1, 2004; 126(4): 1248 - 1254. [Abstract] [Full Text] [PDF]

				A. Stammnitz, A. Jerrentrup, T. Penzel, J.H. Peter, C. Vogelmeier, and H.F. Becker Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnoea Eur. Respir. J., August 1, 2004; 24(2): 273 - 278. [Abstract] [Full Text] [PDF]

				O. Senn, T. Brack, F. Matthews, E. W. Russi, and K. E. Bloch Randomized Short-term Trial of Two AutoCPAP Devices versus Fixed Continuous Positive Airway Pressure for the Treatment of Sleep Apnea Am. J. Respir. Crit. Care Med., December 15, 2003; 168(12): 1506 - 1511. [Abstract] [Full Text] [PDF]

				P. L. Smith, C. P. O'Donnell, L. Allan, and A. R. Schwartz A Physiologic Comparison of Nasal and Oral Positive Airway Pressure Chest, March 1, 2003; 123(3): 689 - 694. [Abstract] [Full Text] [PDF]

				C. A. Massie, N. McArdle, R. W. Hart, W. W. Schmidt-Nowara, A. Lankford, D. W. Hudgel, N. Gordon, and N. J. Douglas Comparison between Automatic and Fixed Positive Airway Pressure Therapy in the Home Am. J. Respir. Crit. Care Med., January 1, 2003; 167(1): 20 - 23. [Abstract] [Full Text] [PDF]

				S. T. Kuna A 54-Year-Old Man With Obstructive Sleep Apnea JAMA, October 23, 2002; 288(16): 2032 - 2039. [Full Text] [PDF]

				W. W. Flemons Obstructive Sleep Apnea N. Engl. J. Med., August 15, 2002; 347(7): 498 - 504. [Full Text] [PDF]

				O. Marrone, G. Insalaco, M. R. Bonsignore, S. Romano, A. Salvaggio, and G. Bonsignore Sleep Structure Correlates of Continuous Positive Airway Pressure Variations During Application of an Autotitrating Continuous Positive Airway Pressure Machine in Patients With Obstructive Sleep Apnea Syndrome Chest, March 1, 2002; 121(3): 759 - 767. [Abstract] [Full Text] [PDF]

				F. Series and I. Marc Importance of sleep stage- and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy Eur. Respir. J., July 1, 2001; 18(1): 170 - 175. [Abstract] [Full Text] [PDF]

				P. Lévy and J.-L. Pépin Autoadjusting Continuous Positive Airway Pressure . What Can We Expect? Am. J. Respir. Crit. Care Med., May 1, 2001; 163(6): 1295 - 1296. [Full Text]

				W. J. RANDERATH, O. SCHRAEDER, W. GALETKE, F. FELDMEYER, and K.-H. RUHLE Autoadjusting CPAP Therapy Based on Impedance Efficacy, Compliance and Acceptance Am. J. Respir. Crit. Care Med., March 1, 2001; 163(3): 652 - 657. [Abstract] [Full Text] [PDF]

				M.-P. d'Ortho, V. Grillier-Lanoir, P. Levy, F. Goldenberg, E. Corriger, A. Harf, and F. Lofaso Constant vs Automatic Continuous Positive Airway Pressure Therapy : Home Evaluation Chest, October 1, 2000; 118(4): 1010 - 1017. [Abstract] [Full Text] [PDF]

				M P Bureau and F Sériès Comparison of two in-laboratory titration methods to determine effective pressure levels in patients with obstructive sleep apnoea Thorax, September 1, 2000; 55(9): 741 - 745. [Abstract] [Full Text]

				F. SÉRIÈS Accuracy of an Unattended Home CPAP Titration in the Treatment of Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 94 - 97. [Abstract] [Full Text]

				D. I. Loube Technologic Advances in the Treatment of Obstructive Sleep Apnea Syndrome Chest, November 1, 1999; 116(5): 1426 - 1433. [Abstract] [Full Text] [PDF]

				J H Ficker, G H Wiest, G Lehnert, B Wiest, and E G Hahn Evaluation of an auto-CPAP device for treatment of obstructive sleep apnoea Thorax, August 1, 1998; 53(8): 643 - 648. [Abstract] [Full Text]

				R. FARRE, R. PESLIN, J. M. MONTSERRAT, M. ROTGER, and D. NAVAJAS Flow-dependent Positive Airway Pressure to Maintain Airway Patency in Sleep Apnea-Hypopnea Syndrome Am. J. Respir. Crit. Care Med., June 1, 1998; 157(6): 1855 - 1863. [Abstract] [Full Text] [PDF]